HomeMy WebLinkAboutBLD2025-00776 - BLD CD Environmental Health Review - 6/27/2025 �`�-r t, MASON COUNTY COMMUNITY SERVICES Permit No: E(r11 ORS S�01 °/
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PERMIT ASSISTANCE CENTER: V.
ButwiNG••PLANNING••PUBLIC HEALTH••PRE MARSHAL
1 •of• 615 W.Aides Street.Shelton,WA 98564
'-!� 1 Plore Shelton:(360)4274670 ext 352-Fax:1360)427-7TB8 Phone J U N 2 5 2025 �� C./� ��
� 6alf it(360)27St467•Phone F)t+e:(360)482-5269
. BUILDING PERMIT APPLICATION �t� .
615 W. Alder Steel, N . _ •.
PROPERTY OWNER INFORMATION: CONTRACTOR INFORMATION:
NAME: go b¢ /'o tJ n "! ;p NAME:, n[t.va este.1 S f re...a er u ah:F s."OS Ll.'� i
MAILING ADDRESS:1G/ SFr.44co..w1, WhJ MAILING ADDRESS:/ .rt c, LQ se 411_
CITY:SL...l.19v. STATE:VJ_ZIP: a85gH CITY: 15( e.�p/es_ STATE:A 4E ZIP: 1flaI
PHONE#1: 160 k46 --y47fN PHONE ;SMS. s1CFI I- r----
PHONE#2: EMAIL:1 ....L? o..sI.g -Co i ies.d<_ .Ca..•1
EMAIL:k•tr/�.te-g(sa;le 1.P94...A�l-(D w L&IREG#D ZCtAC 74i.e.� Ea0/1/ ! 7 = ma.
PRIMARY CONTACT: OWNER❑ CONTRACTOR lc OTHER❑ Zr
NAME A)!G 'S(-$4., EMAIL QJ ,e e-0 f^.>FGr, ' 4"
MAILING ADDRESS ICt7 F•_reCICAO 4E f ( CITY Oil 0.4Ot.... STATE,Iitt- ZIP 14 Ss./ D
PHONE - CELL S .tVj0 CO-1itS-I9 r
PARCEL INFORMATION: G�
PARCEL NUMBER(12 Digit Number)22a 3G I Oa KQ S Q ZONING '15F
LEGAL DESCRIPTION(Abbreviated)T,C S of 6o+t T Les 7 S i rt. S MeiptE D'.STRICT 0,\
SITE ADDRESS 36( SE �CC.nMb Was i CITY 51..�,/-1ati e t </G �g
DIRECTIONS TO SITE ADDRESS __ �O ,
IS THE PROJECT WITHIN 300 FT OF SLOPE(S)GREATER THAN 14%: YES❑ NO V SNOW LOAD:&psf
IS PROPERTY WITHIN 200 FT OF THE FOLLOWING: (axk ell sloe apyly):
SALTWATER g' LAKE 0 RIVER/CREEK❑ POND❑ WETLAND❑ SEASONAL RUNOFF 0 STREAM 0
TYPE OF WORK:_ NEW❑ ADDITION❑ ALTERATION g REPAIR g OTHER ❑
USE OF STRUCTURE Okeasses.Garqts.Co...00al ally Is) Le.S I de r+
IS USE: PRIMARY tif SEASONAL❑ NUMBER.OF BEDROOMS 3 NUMBER OF BATHROOMS 0_
HEATED STRUCTURE? YES(whole aide® YES(p/ms(=J efBldg❑ NO❑
DESCRIBE WORK Qin w Ib✓av¢-1O r't
• SQUARE FOOTAGE:(,ropoeer
1ST FLOOR 63 Z.sq.ft. 2ND FLOOReliV.-sq.ft. 3RD FLOOR sq.fr. BASE.'ENT1?3J:2-sq.ft
DECK sq.ft. COVERED DECK _sq.& STORAGE sq.ft OTHER sq.ft.
GARAGE sq.ft.Attached 0 Detached❑ CARPORT sq.ft Af,,,,hddliejetached❑
eZ
MANUFACTURED HOME INFORMATION: *4 COPIES OF THE FLOOR PLAN REQUIRED* �
_,_
MAKE MODEL YEAR LENGTH
WIDTH BEDROOMS BATHS SERIAL NUMBER
ENVIRONMENTAL HEALTH:
....-Y
SEWAGE/SEWERSOURCE: SEPTIC( SEWER❑ / NEW❑ EXISTdTIN
PLUMBING LN STRUCTURE? YES 0 NO❑ if yet,attach completed Water Form t ki)
PEIUMETERJFOUNDATION DRAINS PROPOSED? YES❑ NOD EXISTING SQ.FT.
EXISTING BEDROOMS 3 PROPOSED BEDROOMS 0 TOTAL BEDROOMS 3 cf.)
OWNER admowledges pat wtmisslon of iiacarate Information may result ih a stop work Defer or pewit revocation.Acknowledgement of such Is by
signature below.I dedara that I am the seeier and I further declare that I am entitled to receive this peen*and to do the work as proposed I have
obtained permission from all the necessary parties.inducing any easement folder or parties of interest regarddW this praised.The owror or legal
re;xese tatfve,repesen'a that the Information provided is accurate and grants employees of Meson Carry access to the above described property
and s W chm(s)for review and Inspection.This pertnhlappdmrm became*null 6 void If work or authorized construction is not commenced sd8hin 183
days or if constnxdcw work 6 suspended for a period of 180 days.
PROOF OF CONTINUATION OF WORK ON THIS PERMIT IS BY MEANS OF INSPECTION. INACTIVITY OF THIS
PERM F 180 DAYS OF MORE WILL CAUSE THE APPLICATION TO BE EXPIRED.(MASON
COUNTY CODE 14.68.42)
X o6 7t r/Gs
gala re of si ad OWN Date
114JAT-F 'TALR : QYE.pF:,:Ij,A,' '':•'t_D. '1.I DATE -l'AGS!NUTF !C.OINi Q '
BUILDING DEPARTMENT
PLANNING DEPARTMENT
FIRE MARSHAL
PUBLIC Wi-/ ii/uI1< L4 At4,ok
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